Does it look like new blood vessels are forming inside your eye? Shall we talk about this neovascularization of the eye?

Sometimes our eyes get unexpected problems, don't they? Suddenly, our vision becomes blurry, or our eyes become red and painful. There may be a condition behind these things that we haven't heard much about. One such condition is ocular neovascularization, or the formation of new blood vessels inside the eye.

What is the formation of new blood vessels in the eye? (Neovascularization of the Eye)

Simply put, this is when new blood vessels form inside the eye. However, these blood vessels grow in places they shouldn't, in ways they shouldn't, and sometimes in excess . They grow like weeds. New fibrous tissues can also form between these new blood vessels. That's when vision begins to be affected.

This is what we medically call ``Neovascularization``, the formation of new, unwanted blood vessels inside the eye. This can lead to inflammation and scarring inside the eye, which can eventually lead to reduced or complete loss of vision . Most often, this condition is caused by an injury or ongoing disease .

Where in the eye can these new blood vessels form?

Now let's see which parts of the eye these new blood vessels can affect. The eye is a very complex and delicate organ.

• Choroid: This is located between the retina and the sclera, the white part of the eye. This is where most of the blood vessels that supply blood to the eye are located.
• Retina: This is where light entering the eye is converted into electrical signals and sent to the brain. This is what allows us to see things.
• Macula: This is located in the center of the retina. It helps us see things that are directly in front of us clearly.
• Iris: This is the part of the eye that gives it its color. The small black circle in the middle, which is the pupil , is also located here.
• Cornea: This is the clear, glass-like part of the eye at the front, like a window.
• Conjunctiva: This is a thin membrane that protects the eye.

Formation of new blood vessels in the vascular layer `(Choroidal Neovascularization - CNV)`

Now let's look at this `(Choroid)`, that is, the formation of new blood vessels in the vascular layer. This is called `(Choroidal Neovascularization - CNV)`.

This is most commonly seen in people with age-related macular degeneration (AMD). Doctors believe that the cause is increased levels of a chemical called Vascular Endothelial Growth Factor (VEGF), which is produced by the retina of a person with AMD.

These new blood vessels are not normal. They are very weak, like a broken pipe.This can cause fluids, and sometimes even blood, to leak into the retina. Think of it like a small balloon filled with water, and a blister can form on the retina.

These causes of `(CNV)` can also cause new blood vessels to form in the central retina (Macular Neovascularization - MNV). However, sometimes `(MNV)` can occur without any reason. In such cases, it is also called `(Idiopathic)`, which means "of unknown cause".

Corneal Neovascularization

Next, let's talk about the formation of new blood vessels in the cornea. Remember, the cornea is the clear part of the eye. Normally, it has no blood vessels at all. That's why it's so clear. So, if new blood vessels form in it, that clarity can be disrupted, and it can look like a fog. This can cause vision to become blurry.

This ``Corneal Neovascularization`` is associated with various eye conditions.

Retinal Neovascularization

Retinal neovascularization is the formation of new, abnormal blood vessels in the retina. Remember, the retina is where the light-sensing cells are located. This condition can be caused by various diseases and injuries. These new blood vessels are weak and can bleed and leak fluid.

Neovascularization of the Iris

Iris Neovascularization is the development of new and abnormal blood vessels in the iris – the part of the eye that gives color to the eye. It is also called Rubeosis Iridis. It is associated with a severe type of glaucoma called Neovascular Glaucoma. Glaucoma is a disease that damages the optic nerve and is a major threat to vision.

What are the symptoms of this condition?

Now let's see what symptoms we feel and see when new blood vessels form inside the eye. These symptoms may vary depending on where the new blood vessels have formed.

If new blood vessels form in the choroid and macula:

• Things you see may appear distorted and distorted , like looking through water or through a distorted mirror.
• When you look straight ahead, you may see a blank space or a black spot in the middle of your vision.

If new blood vessels form in the cornea (Corneal Vascularization):

You may not have any symptoms at all. However, if you do, you may experience the following:

• Eye pain.
• Redness of the eyes.
• Watery eyes.
• Sensitivity to light (Photophobia) - This means difficulty looking at things like sunlight and bright lights.
• If you wear contact lenses, you may not be able to wear them for more than a few hours.

Why is this happening? What are the reasons?

Okay, now let's look at why new blood vessels form inside the eye in this way, and what the causes are. The reasons for these formations are slightly different in each place.

Causes of new blood vessels forming in the choroid and macula:

• Macular degeneration: This is the main cause.
• Extreme nearsightedness.
• Ocular histoplasmosis is a fungal infection of the eye.
• Eye injury.
• Angioid streaks: These are like cracks that form in one of the layers of the retina.
• Uveitis: This is a group of eye diseases that can cause inflammation inside the eye, redness, and eye pain.

Causes of new blood vessels forming in the cornea:

• Congenital diseases: These are diseases that are present at birth.
• Eye trauma: For example, chemical burns.
• Infectious keratitis.
• Allergies.
• Immune system and inflammatory disorders.
• Prolonged use of contact lenses can cause tissue oxygen deprivation (Hypoxia).
• Rejection of a corneal graft by the body.

Causes of new blood vessels forming in the retina:

• Retinitis.
• Retinopathy: This includes conditions such as diabetes-related retinopathy, sickle cell retinopathy, and retinopathy of prematurity.
• Reduced blood flow in the main blood vessels in your neck (carotid arteries).
• Retinal vein occlusion: This is the blockage of a blood vessel in the retina.

Causes of new blood vessels in the iris:

• Diabetes-related retinopathy.
• Central retinal vein occlusion.
• Ocular ischemic syndrome: A condition caused by decreased blood flow to the eye.
• Retinal detachment: This is when the retina separates from its supporting tissues.
• Uveitis.

How do you recognize this? What are the tests?

Well, if you have symptoms like these, how does a doctor diagnose it exactly? There are several tests for that.

• Dilated slit lamp eye exam:In this, eye drops are applied to the eye, the pupil is enlarged, and the inside of the eye is examined carefully with a special instrument, such as a microscope.
• Optical Coherence Tomography (OCT): This is like a scan of the inside of the eye. It can take clear cross-sectional images of the layers inside the eye. It can look for things like new blood vessels and fluid leaks.
• Fluorescein angiography or Indocyanine green angiography: This involves injecting a special dye into a vein in your arm and taking pictures of the blood vessels inside your eye. This can clearly show things like blockages and leaks in the blood vessels.

What are the treatments?

Treatment for this condition varies depending on the cause and the part of the eye affected. These treatments usually include medications and/or ablation, which destroys the new, abnormal blood vessels.

Types of medicines:

Some of these are intravitreal injections that are given directly into the eye. These mainly work by controlling a chemical called VEGF and reducing the formation of new blood vessels.

• `Bevacizumab (Avastin®)` (This is used `(off-label)`, meaning it is not for the disease for which it is approved, but because it is known to be beneficial)
• `Brolucizumab (Beovu®)`
• `Aflibercept (Eylea®)`
• `Ranibizumab (Lucentis®)`
• Gene therapy: This is a new treatment method that is still in the research stage.
• MMP inhibitors: For example, a pill called Doxycycline , which is given to stimulate the growth of new blood vessels in the cornea.

Methods that destroy abnormal tissue:

• Laser ablation therapy: This uses laser beams to "burn" and destroy the new blood vessels.
• Photodynamic therapy (PDT): This involves injecting a light-sensitive drug into the eye, then shining a special light into the eye to selectively destroy the abnormal blood vessels.
• Cauterization: This method uses heat to treat abnormal blood vessels.

Also remember: These treatments can have side effects. For example, steroids and anti-VEGF drugs can have side effects that affect the entire body. Also, when they destroy blood vessels, healthy tissue can sometimes be damaged. Therefore, it is important to discuss the pros and cons of each treatment with your doctor and choose the one that is best for you.

What can we do to protect ourselves from this situation?

While this condition cannot be completely prevented, there are things we can do to take care of our eyes and reduce the risk:

• Before making eye contactWash your hands thoroughly with soap.
• If you wear contact lenses, follow the correct instructions for using and cleaning them. Do not wear them for longer than the prescribed period. Remove them when sleeping.
• Ask your doctor about foods and supplements that can help keep your eyes healthy. For people with AMD, there is a type of supplement called AREDS 2 that can help stop or control the progression of the disease in its early stages.
• Follow healthy lifestyle habits. This means eating a balanced diet, exercising regularly , and avoiding smoking. If you have any medical conditions, such as diabetes or high blood pressure, control them well.

What can be expected with this situation?

If this new blood vessel formation is not treated, your vision will gradually decrease and eventually disappear. That would have a big impact on your life, wouldn't it?

There are several factors that affect whether treatment will be successful. These include where the blood clot is, how severe it is, your age, and whether you have other health problems. The sooner it is diagnosed and treated, the better the outcome.

When should I see a doctor?

If you suddenly lose your vision, experience severe eye pain, or have a burning sensation in your eyes that makes it difficult to see light, see a doctor immediately. Also, if you notice any changes in your vision (e.g., blurry vision, black spots), or any other symptoms that you suspect may be a problem, see an ophthalmologist immediately.

It's also important to have regular eye exams as recommended by your eye doctor. If you're at risk for certain eye conditions (e.g., diabetes, a family history of AMD), you may need to go more often.

Are ``Neovascularization'' and ``Angiogenesis'' two different things?

This is a bit of a deep subject, but to put it simply, `(Angiogenesis)` is the process of new blood vessels branching out from existing blood vessels. `(Vasculogenesis)` is the process of new blood vessels starting from cells (as if starting from scratch). `(Neovascularization)` can be used to create new blood vessels in both ways. So `(Neovascularization)` is a bit of a broad term, and it can include all these types of new blood vessel formation.

The most important things we need to remember from this story are

So, we've talked a lot about this condition called ``Neovascularization of the Eye'', where new blood vessels form inside the eye. While this may seem a bit scary, if recognized and treated at the right time, there is a great chance that the condition can be managed and vision can be preserved.

• If you experience a sudden change in vision, redness, pain, or difficulty seeing in bright light, don't delay. See an ophthalmologist immediately.
• If you have conditions like diabetes, hyperopia, or a family history of AMD, get your eyes checked regularly as directed by your doctor.
• Use the medicine your doctor prescribes exactly, follow his instructions, and do not stop treatment midway.
• Avoid smoking completely. Smoking is very harmful to eye health, especially for conditions like AMD and diabetic eye disease.
• A healthy diet and regular exercise are not only good for your eyes, but also for your entire body. Include green vegetables, fruits, and fish rich in omega-3 in your diet.

Remember, your eyes are very precious. They are the most valuable resource we have to see the world. Therefore, it is your responsibility to take good care of them. If you are aware in advance and take the necessary steps, you can avoid many problems.

` Neovascularization of the Eye, Eye Diseases, Vision, Retina, Ophthalmology, Eye Treatment